SME-Claims HC

Job Summary

We are seeking a Subject Matter Expert in Claims HC with 4 to 6 years of experience to join our team. The ideal candidate will have expertise in UiPath and Claims Adjudication along with domain experience in Provider and Payer. This hybrid role requires working night shifts and does not involve travel. The candidate will play a crucial role in optimizing claims processes and enhancing operational efficiency.

Responsibilities

• Lead the automation of claims processes using UiPath to improve efficiency and accuracy.
• Oversee the end-to-end claims adjudication process to ensure timely and accurate resolution.
• Provide expert guidance on claims management to both provider and payer teams.
• Collaborate with cross-functional teams to streamline claims operations and reduce processing times.
• Analyze claims data to identify trends and implement strategies for process improvement.
• Ensure compliance with industry regulations and standards in all claims-related activities.
• Develop and maintain documentation for claims processes and automation workflows.
• Train and mentor junior staff on best practices in claims adjudication and automation.
• Monitor and report on key performance indicators related to claims processing.
• Work closely with IT teams to integrate UiPath solutions with existing systems.
• Facilitate communication between provider and payer teams to resolve claims issues.
• Participate in continuous improvement initiatives to enhance claims operations.
• Support the development of new claims adjudication policies and procedures.
  
  

Qualifications

• Possess strong technical skills in UiPath with a proven track record in automation.
• Demonstrate expertise in claims adjudication with a deep understanding of industry practices.
• Have substantial experience in the provider and payer domains ensuring comprehensive knowledge.
• Exhibit excellent analytical skills to interpret claims data and drive improvements.
• Show proficiency in collaborating with cross-functional teams to achieve common goals.
• Display strong communication skills to effectively liaise with various stakeholders.
• Maintain a proactive approach to problem-solving and process optimization.